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The Centers for Disease Control and Prevention publishes data about drug overdose mortality rates in every state, annually. Here is a look at the states ranked by overdose-related death rates for 2016, the most recent year available.

Synopsis of Slides: (see original article for all)

#50: The overdose death rate in Nebraska is 6.4 per 100,000 residents, the lowest in the nation.

Bioengineer on 11/20/2018 by Bioengineer, Credit: Medical University of South Carolina

When patients with dependence on alcohol, cocaine or nicotine are shown drug cues, or images related to the substance, an area of their brain known as the medial prefrontal cortex (mPFC) shows increased activity, report investigators at the Medical University of South Carolina (MUSC) in an article published online September 7, 2018 in Translational Psychiatry.

“We asked the question: ‘Which brain area is more engaged when these patients see a drug cue versus a neutral cue?'” explains Colleen A. Hanlon, Ph.D., associate professor in the Department of Psychiatry and Behavioral Sciences at MUSC and senior author on the study.

To answer this question, Hanlon and her team imaged areas of increased brain activity, or ‘hot spots,’ in response to drug cues. They recruited three categories of substance users: chronic cocaine users, heavy alcohol users and cigarette smokers. They imaged brain activity using functional magnetic resonance imaging (fMRI). During fMRI sessions, the participants were shown images of cocaine-, alcohol- or cigarette-related cues alternated with matched neutral images. For example, a cue for cigarette smokers was an image of a person holding a cigarette, while the matched neutral image showed a person holding a pencil. The physiological reaction to drug cues, or cue-reactivity, is indicative of substance use disorder and often leads to drug use.

Participants in all three cohorts of substance use (cocaine, nicotine, and alcohol) exhibited ‘hot spots’ in the mPFC when cues were presented.

Hanlon and her team are dedicated to mapping neuronal circuits using neuroimaging techniques to better understand addiction. Specifically, they aim to find a region of the brain that can be targeted by transcranial magnetic stimulation (TMS) therapy. TMS is a noninvasive procedure used to modulate neural networks. It works by applying a magnetic field to a specific area of the brain to either stimulate or attenuate electrical activity. Because many of the ‘hot spots’ identified by the study were located at a depth of five centimeters or less, they can be reached by TMS therapy, showing the feasibility of using TMS for substance use disorder. Continue reading →

It’s not because teens are consuming weed more, it’s because they’re using tobacco and alcohol less

Teens used to try alcohol first, then tobacco, and then marijuana. Now, marijuana is increasingly the first “gateway” substance for adolescents, according to new research.

This trend is not because teens are smoking cannabis more than ever. Rather, the change is because teens are smoking cigarettes and drinking less while the numbers for marijuana have held steady, according to Katherine M. Keyes, a professor of epidemiology at Columbia University and co-author of the new study, published this week in the journal Drug and Alcohol Dependence.

“As we’ve seen the dramatic declines in alcohol and tobacco, we haven’t seen dramatic declines in marijuana, so now every year it’s more and more likely that kids are starting their drug-use careers with marijuana,” says Keyes. She adds that rates of teen drinking and smoking started to fall — thanks largely to widespread public health campaigns — long before the recent wave of pro-marijuana lobbying.

GATEWAY SEQUENCES ARE MALLEABLE

The authors found this by analyzing 40 years of surveys from American high school seniors. For example, in 1995, three-fourths of seniors who used both marijuana and cigarettes had tried cigarettes first. By 2016, only 40 percent had tried cigarettes first. Today, less than half of teens try alcohol and cigarettes before trying cannabis. (The researchers didn’t look specifically at whether alcohol or tobacco came next.) Other studies have found that, in general, teens are doing fewer drugs than ever, except for marijuana.

Most likely, this trend will continue as marijuana becomes less stigmatized and more and more states vote to legalize the drug. Though teens aren’t supposed to smoke marijuana even in the states that have fully legalized it, “it’s not going out on a huge limb to suggest that marijuana is going to be more available at a lower cost to adolescents,” says Keyes. “If you make a substance more available at a lower cost and easier to access, you’re gonna see increases.” After all, it’s also illegal for kids to drink or smoke, but many easily find both alcohol and cigarettes in their own homes.

One important caveat is that the tobacco information only refers to traditional combustible cigarettes and doesn’t take into account the spike in underage vaping (though vaping alone doesn’t account for the lower levels of smoking). “If anything, what this paper shows is that gateway sequences are malleable and very context-specific,” says Keyes. “When you think about substance use in adolescents, you kind of have to keep your eye on the whole picture and not do it substance by substance. The next product that comes onto the scene and delivers nicotine in a way young people like could create a different sequence.”

Alex, 22, overdosed and died in a motel room just a few miles from his drug rehab facility.

SAN FRANCISCO — It has been dubbed “the Florida Shuffle.” Drug addicts from across the country get lured to the Sunshine State for decades with the promise of treatment, only to be traded from one unscrupulous drug rehab to another. Meanwhile, the patient’s insurance company gets milked for tens of thousands of dollars in fraudulent charges.

Many have overdosed and even died in the process, prompting Florida lawmakers to crack down on the scam.

“He called me when he was in treatment and started telling me about California,” said Rich Strickling, who lives in Ohio. He said he had a feeling something was up when his 22-year-old son Alex, a recovering heroin addict, called to tell him he was planning to leave his treatment center in Florida for a new rehab facility in California.

Days later, he got another call: Alex had overdosed and died in a motel room just a few miles from his drug rehab facility.

“Somewhere I was building some type of wall waiting for the day that it happened to my son, but nothing prepares you for that,” said Strickling.

When he learned how the overdose happened, the pain turned to anger. “There was somebody whispering in his ear,” said Strickling.

It turns out that a person Alex met in treatment was offering him money and airfare to switch to a new rehab in Beverly Hills. “I had all the text messages after my son passed away,” said Strickling.

In a first text, a person asked: “Wanna go to Cali?”

“I’ll send you like $200 to get you established out there and on top of that you get 2 packs of smokes a day, haircuts and gym.”

“I’m pretty sure I am down,” Alex responded,

Days passed. Then the messages became more urgent.

“What’s the word homie? You ready? Cali’s calling your name,” the next set of texts said.

Then the person spells out in detail what was needed: “Send me your insurance info and I’ll run it to get you approved.” Another text said, “Send it tomorrow I’ll throw you the cash after 17 days, broski.”

“I trust you lemme get back to you tomorrow with my info,” Alex responded. After Alex sent his insurance information, radio silence followed.

Strickling now knows why. “That same person that does that hard sell on you, they’re going to tell you towards the end of that process that, you know you have to fail your urine test in order for them to justify getting you into treatment,” said Strickling.

From Virginia to Alaska, methamphetamine use is surging — and it’s hitting in many places still reeling from the opioid crisis

In the shadows of the nationwide opioid crisis, another threat looms. Methamphetamine use is on the rise in small rural pockets of the country, from Oklahoma and Virginia, to Kentucky and Florida, and, as Rolling Stone reported in August, all the way up north in Alaska. The drug’s previous rise to prominence in the 1990s stemmed from the development of new synthesizing methods that allowed amateur chemists, armed with cold medicine and common household cleaning products, to “shake and bake” at home. It took a while, but 2006’s Combat Methamphetamine Epidemic Act, which limited over-the-counter access to cold medications containing necessary ingredients for synthesizing the drug, reduced domestic meth lab seizures to its lowest rate in 16 years. But the market for meth never went anywhere, it just got a new supplier. Nowadays, most of the country’s meth hails from Mexico, where “superlabs” run by drug cartels churn out a product that is purer and cheaper than ever — and there’s a hell of a lot more of it to go around.

These superlabs, largely operated by Mexico’s Sinaloa drug cartel, are able to produce at an industrial scale, cooking up hundreds of pounds a day, and testing at 95 to 99 percent purity – what law enforcement calls “crystal” or “ice.”

“They came in with much purer, much cheaper meth and just flooded this region of the country,” DEA Agent Richard Salter told CNN about the impact being felt in Oklahoma, where fatal overdoses from the drug have doubled over the last five years.

As Rolling Stone first reported in August, Alaska saw meth-related overdoses quadruple between 2008 and 2016. Similarly, in Florida, according to the Department of Law Enforcement’s 2016 report, fatal meth overdoses were four times higher than they were just six years earlier. And in Southwest Virginia, according to a new report, within two years, meth seizures tripled, overtaking heroin as the second leading drug of choice (after marijuana).

The cartels are producing so much meth that they’ve broadened the scope of distribution beyond just those areas already ravaged by addiction, like the midwest and Pacific Northwest, targeting new markets on the East Coast and Southern United States. According to the U.S. Border Patrol, meth seizures have multiplied tenfold over the last eight years, increasing from 8,900 pounds in 2010 to nearly 82,000 pounds so far in 2018. But a lot more is slipping through the cracks, trafficked across the border through California and Arizona — where seizures of meth are up 500 percent in the past decade — and making its way to distribution hubs like Atlanta, where it’s funneled into smaller, rural communities, often through established prison networks with connections to the formerly incarcerated.

With plenty to go around, meth is a lot cheaper too. In Oklahoma in 2012, an ounce of meth cost approximately $1,100, but now goes for $250 to $450. Law enforcement officials in Virginia, Ohio and Florida report a similar price drop. Illegal drugs are always sold at a premium in Alaska, and while the cartels continue to exploit the remote market’s lack of competition, meth is still cheaper now than it was the previous decade. Continue reading →

With college costs rising and a shortage of skilled trade workers, trade school offers students an alternate path to a promising career.

In a world where college costs are rising and student loans can be stifling, high school students and their parents are increasingly looking for alternatives to expensive four-year college programs.

One alternative that has been gaining national attention is trade school. With a nationwide shortage of skilled labor, trade school can offer a non-traditional path to a well-paid and stable career. According to the National Center for Education Statistics, the employment rate for people with occupational credentials — such as those obtained in trade school — is actually higher than the employment rate for those with academic credentials.

In addition to strong prospects for employment, skilled trade professions also offer competitive salaries which fall well above the minimum wage. According to the Bureau of Labor Statistics, the median salary for an HVAC technician in 2017 was $49,530. The median salary for a plumber was $52,590.

Those numbers are likely to climb even higher, too. With a shortage of skilled trade workers and an increase in new construction starts in the state of Indiana, there will be plenty of well-paid work for plumbers, HVAC technicians, electricians and other workers. That shortage of skilled trade workers has very real consequences, from a shortage of housing to longer wait times to get an air conditioner fixed.

Combined, these statistics all point to the same thing: the need for more skilled trade workers throughout the state of Indiana and the entire country. Respondents to Manpower Group’s 2018 Talent Shortage Survey cited skilled trade workers as the hardest positions to fill in the United States.

It’s no surprise, therefore, that everyone from educational experts to politicians on both sides of the aisle are calling for more robust trade school attendance as a solution to the shortage of skilled trade workers.

During a speech in 2014, for example, former President Obama encouraged more students entering the trades, saying that “a lot of young people no longer see the trades and skilled manufacturing as a viable career. But I promise you, folks can make a lot more, potentially, with skilled manufacturing or the trades than they might with an art history degree.”

Four years later, President Trump established a workforce policy advisory board aimed at improving vocational education and job training, according to the White House. The move shows that getting more students to fill the labor market’s skilled trade gap is truly of national importance.

Even as the benefits of trade school have been gaining attention from high-level experts and the media, students themselves may not be getting the message. That may, in part, be a residual side effect of a decades-long cultural emphasis on a four-year college degree.

“Since the 1980s educators have been placing more emphasis on preparing students for college at the sacrifice of vocational training,” said Scott Shaw, president and CEO of Lincoln Tech.

While the friends, family members and college counselors urging high school students to pursue a college degree likely have the best intentions, students who don’t consider other options like vocational training may miss out on a great economic opportunity.

“There are hundreds of thousands of jobs going unfilled each year in fields that don’t require a college degree and so many students are being over-educated,” Shaw said.

Whether it’s an interest in starting a career right away, innate technical skills, a desire to work with their hands or a desire to avoid the high price tag that comes with college, there are many reasons that trade school could also simply be a better fit for any given student. By assessing their individual talents and goals instead of jumping into a four-year degree program, students can end up on the path that makes the most sense for them.

Even when college may not be the best fit, though, there can sometimes be a stigma attached to attending trade school that pushes some students away. The same social pressures that can push students towards college can also push them away from trade school.

“The stigma has caused fewer people to think about and pursue many careers which are desperately needed to keep our economy moving forward,” Shaw said. “By erasing the stigma surrounding vocational training, we can ensure that employers in these fields can remain competitive by recruiting from a constant influx of new talent.” Shaw said.

The stigma problem may disappear on its own, notes Jonathan Farley, a Doctor of Philosophy who has studied educational incentives. The more successful tradesmen people see, said Farley, the more the stigma surrounding trade school will disappear.

“There is a funny episode of Frasier in which Frasier’s brother tries to impress a man he knew in school by talking about his expensive BMW. The man, now a plumber, then said that he found that that model BMW was too small for his family, so he got a bigger one. Success is the best response,” Farley said.

As news gets out that attending trade school can provide a direct path to a rewarding career, the stigma associated with trade schools may correct itself. Smart students will make smart financial decisions — and sometimes that decision will be going to trade school.

That’s good news for students, for the economy, and for anyone still waiting to get their air conditioner fixed.

A man arguing that a trial court abused its discretion in imposing an advisory sentence without issuing a statement lost his case when the Indiana Court of Appeals found that under Indiana code, courts are not required to issue statements for advisory felony sentences.

In May 2008, Anthony Ward, Sr., pleaded guilty to Level 5 felony auto theft and Class A misdemeanor resisting law enforcement after he a stole a woman’s car from a liquor store parking lot. Ward received an aggregate four-year sentence, but contended that his three-year sentence for the auto theft conviction was an abuse of the Allen Superior Court’s discretion because the trial court did not enter a sentencing statement.

But the appellate court found that under the plain language of Indiana Code Section 35-38-1-1.3 (2018), a trial court “is not required to issue a sentencing statement where, as here, it imposes the advisory sentence for a felony conviction.”

Ward acknowledged that the trial court was not required by statute to enter a sentencing statement, but continued to argue that the statute was incompatible with the Supreme Court’s holding in Anglemyer v. State, 868 N.E.2d 482 (Ind.).

“Still, Ward contends that ‘Anglemyer’s requirement of a sentencing statement, and the importance of that statement, remain a cornerstone of Indiana sentencing law even after I.C. § 35-38-1-1.3 was passed by the legislature,’” Judge Edward Najam wrote.

Despite his arguments that the court was still required to follow the dictates of Anglemyer, the appellate court ultimately decided the statute was clear and unambiguous.

“In sum, a trial court is not required to enter a sentencing statement if it imposes the advisory sentence for a felony conviction,” Najam concluded. “…Here, because the trial court sentenced Ward to the advisory sentence of three years for a Level 5 felony, the trial court was not required to enter a sentencing statement. Thus, the trial court did not abuse its discretion when it sentenced Ward, and we affirm Ward’s sentence.”

Recent analyses show that people in the construction industry are six times more likely to die of an opioid overdose than other workers.

Construction workers are dying from opioid overdoses across the country, both because they are often forced to work hard jobs through the pain of injuries in order to provide for their families—and because there is money to be made off their pain.

A recent report from the Massachusetts Department of Public Health shows that people working in construction are six times more likely to die an opioid-related death than all other workers in the state. That means nearly a quarter of all people who died from opioid overdoses in Massachusetts, a state with one of the highest overdose rates in the country, were employed in construction.

Elsewhere in the country, overdose death rates for construction workers are even higher. In Ohio, they are seven times more likely than other workers to die from an overdose in 2016, according to an analysis by The Plain Dealer. That’s roughly the same rate the Midwest Economic Policy Institute found across the entire Midwest—which also includes Illinois, Indiana, Iowa, Michigan, Minnesota, and Wisconsin.

The lethal link between construction work, pain, injury, and powerful painkillers is no mystery to researchers or people in the industry. In one study, 75 percent of workers said they were recently dealing with musculoskeletal pain and four out of ten said they’d been injured in the month before.

“You get injured at work, you get a prescription for that injury that potentially develops into some sort of misuse, or if you don’t get a prescription maybe you move onto getting the drugs some other way,” explains Devan Hawkins, one of the authors of the Massachusetts study and an instructor of public health at the Massachusetts College of Pharmacy and Health Sciences.

Those injuries are not necessarily dramatic emergencies but the daily grind of, say, lifting 3.8 tons of bricks day-in and day-out. Working in construction is a taxing job that leaves 40 percent of its older workers with chronic back pain. “It’s not only about injuries, it’s also about pain,” says Hawkins. “There is a high prevalence of pain among construction workers just to be able to do this sort of work.” Continue reading →

While the recreational use of marijuana is an increasingly a legalized activity, the exact science of what the drug does to the brain isn’t yet conclusive. In an effort to understand what happens to the brain right from the start of smoking, scientists recently studied the substance use of nearly 4,000 teenagers in Canada. Their research indicates that marijuana not only affects teenagers’ cognitive abilities, it also has more long-term consequences on working memory than alcohol.

In the study, published Wednesday in the American Journal of Psychiatry, scientists from CHU Sainte-Justine and the University of Montreal determined that when teenagers consistently and increasingly use marijuana, cognitive functions like recall memory, perceptual reasoning, inhibition, and working memory are damaged. While both alcohol and marijuana affect how teen’s brains work, senior author Patricia Conrod, Ph.D. said Wednesday that “increases in cannabis use, but not alcohol consumption, showed concurrent and lagged effects on cognitive functions.”

For the study, Conrod and her team evaluated 3,826 seventh grade students from 31 schools in the Greater Montreal region for four years. Once a year, the researchers would ask the students to rate the frequency of their marijuana and alcohol consumption on a six-point scale. Students were assured that parents and teachers wouldn’t have access to the information unless their habits indicated an imminent risk of harm.

Next, the teens’ cognitive functions were assessed through a variety of memory tests. For example, a delayed recall test involved reproducing a previously learned pattern of stimuli 30 minutes later. In a perceptual reasoning test, teens were asked to complete a sequence of increasingly difficult puzzles, and in an inhibitory control test, teens had to learn by trial and error when to respond to “good” or “bad” numbers.

These tests, paired with the reports about the teens’ substance use, revealed that individuals who used cannabis and alcohol were more likely to show worse working memory, perceptual reasoning, and inhibitory control. The findings are in line with previous research, but the novel part of the study is the revelation that cannabis could be worse for growing brains.

“Over and above the effect of being prone to cannabis use during adolescence, when increases in cannabis use frequency were observed in a given year, reductions in delayed recall memory and perceptual reasoning were observed in that same year, and these effects were independent of any changes in alcohol quantity and frequency,” the authors write.

This conclusion differs from previous research that touches on a much-debated question: What’s worse for your brain, marijuana or alcohol? A 2017 study from the University of Colorado-Boulder came to the opposite conclusion, suggesting that the consumption of booze is more detrimental to brains than cannabis. When these scientists looked at the brains of 850 adults and 430 teenagers they found that alcohol led to lower volumes of grey and white matter — essential tissues that affect brain function. Smoking marijuana didn’t result in the same losses.

However, the National Institute on Drug Abuse maintains its stance that “substantial evidence from animal research and a growing number of studies in humans indicate that marijuana exposure during development can cause long-term or possibly permanent adverse changes in the brain.” More studies are needed — especially those that will continue to follow teenagers as they encounter easier access to substances in college — in order to really know the effects these drugs have on cognitive functions. Until then, it can be said that smoking marijuana does come with cognitive repercussions.

The FDA announced on Friday that it would side with its advisory panel by approving a new opioid drug, called Dsuvia, despite the country already being in the midst of an opioid crisis and critics voicing concerns about the safety of the drug.

FDA Commissioner Dr. Scott Gottlieb defended the FDA’s decision to approve the drug, saying in a statement that the “unique aspects” of Dsuvia make it a welcome addition to the tools health care providers already have at their disposal, and added that it would be especially useful for soldiers who cannot obtain intravenous opioids for acute pain. He also stressed that the drug would only be used in medically supervised health care settings.

But with an average of 115 Americans dying every day from an opioid overdose, opponents say enough is enough.

“It is certain that Dsuvia will worsen the opioid epidemic and kill people needlessly,” said Dr. Sidney Wolfe, founder and senior advisor of the nonprofit Public Citizen’s Health Research Group, in a press release.

If you haven’t heard of Dsuvia before, here are some things you should know.

What is Dsuvia?
Dsuvia is a tablet form of sufentanil that’s meant to dissolve under the tongue. It’s five to 10 times stronger than fentanyl, an opioid drug already on that market, and 500 to 1000 times more powerful than morphine. Fentanyl is also produced illicitly and is associated with many overdose deaths, often by those who are unaware that the opioids they’re using contain fentanyl.

Dsuvia is intended for use with patients experiencing acute pain only in medically supervised settings, according to its makers.

Why was this drug developed?
The drug was developed to fulfill an unmet need, according to Dr. Pamela Palmer, anesthesiologist and chief medical officer at AcelRx, the maker of the drug.

“For acute pain management in a hospital, there hasn’t been a new opioid developed in many, many years,” she told ABC News. Right now, if you broke your femur and went into an emergency room, you would either have to be stuck with a needle or they would just give you an oral pill that you would swallow and kind of wait for it to kick in, which could take up to an hour.”

Palmer said there weren’t any opioids available that could dissolve under the tongue for patients who aren’t specifically diagnosed with cancer, experiencing pain, and tolerant to other opioids. “Dsuvia is indicated for… the management of acute pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate,” she said.

Palmer also said that Dsuvia could help health care providers prevent dosing errors that can occur when administering liquid formulations of opioid medications.

What about concerns of abusing Dsuvia?
In addition to making the drug available only in medically supervised settings, AcelRx has other plans for preventing abuse of the drug, Palmer said.

“We have much stricter audits and monitoring and controls where we will have oversight from our manufacturers, from our distributors, wholesalers, all the way to the medically supervised setting,” she said.

The company also has a contract with Denver Health, which runs the RADARS system — a group of programs that are used to monitor prescription drug abuse, misuse and diversion.

Dr. Raeford Brown, chair of the FDA advisory committee on analgesics and anesthetic drug products, was not present to vote on Oct. 12, when the committee voted in favor of the FDA approving the drug — a step that comes before the FDA makes an official decision.

However, he told ABC News that he has significant concerns about the drug, and said in the Public Citizen press release that he was “very disappointed by the decision.”

“It doesn’t seem reasonable to place another potent opioid on the market at this time, especially when we’re currently still writing 200 million prescriptions for opioids a year,” Brown told ABC News. “The need to put a drug like this on the market is not demonstrated. The ability to manage that drug once it gets past the FDA is not demonstrated.”

“We know from looking at other potent opioids that have been put on the market in the last four years that once these drugs get past the FDA, there’s very little, if any, control over them, no matter what the sponsor says prior to the time they come on the market,” he added.

In a press release, Democratic Senator Ed Markey of Massachusetts also expressed concerns about Dsuvia’s potential impact on the opioid epidemic. Massachusetts has some of the highest opioid overdose rates in the U.S., according to the National Institutes of Health.

“An opioid that is a thousand times more powerful than morphine is a thousand times more likely to be abused and a thousand times more likely to kill,” Markey said. “Even in the midst of the worst drug crisis our nation has ever seen, the FDA once again is going out of its way to approve a new supercharged painkiller that would only worsen the opioid epidemic. It makes no sense to approve an opioid painkiller that has no benefits over similar medications and against the advice of experts.”

He added: “I call on the FDA to reject the vote of the advisory committee and stop the approval of this dangerously unnecessary opioid medication.”

Rapacious overselling of painkillers, pushed under the false notion that pain was largely being under-treated, seeded the current opioid and heroin/fentanyl crisis. And doctors, many of them duped by pharmaceutical reps carting around swag and lies that opioid drugs weren’t addictive, helped get us into this crisis by rampant overprescribing. I believe doctors should lead the way in getting us out of this crisis. Too many doctors are unwilling to treat addicted patients, even though they played a role in getting them addicted to opioids. When France expanded its medication-assisted treatment capacity tenfold in the late 1980s, that country’s overdose death rate declined rapidly.

MAT needs to be as accessible to people as street drugs are. The horse is already out of the barn: We have 2.6 million people with opioid use disorder, and physicians helped create many of them. Just because they’re no longer overprescribing opioids doesn’t let them off the hook. They need to do no harm by not abandoning their addicted patients and helping them access treatment.

This is a much harder fix, but especially in inner cities and in rural areas where job losses have been extreme, we need massive retraining and higher-education programs to give young people hope that they, too, can one day have a pathway for meaningful work with a living wage. Studies show that drug use improves when people move to neighborhoods with less economic disadvantage, but people from families with multigenerational trauma who should move are often the least likely to have the social capital and/or money to move.

As addiction specialist Dr. Anna Lembke told me: “It’s important to note, it’s really not just the unemployed and the poor who are vulnerable today; it’s really everybody, especially underchallenged youths or youths who aren’t engaged in school or other meaningful activities.” People whose grandparents or parents were drug- or alcohol-addicted have dramatically increased odds of becoming addicted themselves, so those children should be identified and targeted to receive evidence-based prevention treatment in schools. None of these things are a cheap and easy fix, but we can’t afford not to implement them.

Felony records severely limit people’s ability to obtain employment, sending many people back to dealing drugs in order to eat and/or pay their bills and court fines and child-support arrears. Ronnie Jones’s story in “Dopesick” is a great example of that. Lacking opportunity for work, he simply went back to what he knew — dealing drugs. I’m not excusing him for that — he broke the law multiple times and helped seede addiction in his community — but it would have been so much cheaper for society if the government would have spent a little time and money helping Jones find work upon re-entry than spending hundreds of thousands investigating, prosecuting and re-incarcerating him for 23 years.

On Election Day, Ohioans will vote on a ballot initiative designed to help decriminalize nonviolent drug use and to divert millions of taxpayer dollars — currently spent pursuing an outdated and failed war on drugs — into drug treatment programs. By challenging perceptions of drug users, Issue 1 upends racist assumptions the nation has accepted for decades.

The proposed constitutional amendment will decrease Ohio’s prison population by turning nonviolent felonies into misdemeanors that don’t require prison time, allow those with existing convictions to be eligible for those to be reclassified as misdemeanors, and prohibit prison time for people who violate probation for noncriminal offenses (such as being late for an appointment), among other humane policy shifts.

Ultimately, Issue 1 pushes back on draconian drug sentencing enacted at the height of the crack cocaine explosion of the ’80s and ’90s that led to disproportionate incarceration rates for black people, the poor and the undereducated. For the moment, it places the state at the epicenter of the ongoing struggle between U.S. citizens and lawmakers over the inherent racism of national drug policy that deemed black Americans expendable.

According to the U.S. Census Bureau, Ohio’s state prison population is around 52,000 (roughly the size of Cleveland suburb Lakewood). Although black people represent only 12% of the population, 43% of the state’s prison population is black. By contrast, while whites represent 81% of Ohio’s population, they represent 52% of the prison population.

These statistics aren’t altogether new. Ohio’s prison population topped 45,000 in 1996 and has remained above that level ever since. The vast racial disparities persist relatively unchanged. In 2004, not long after the publication of my book The Hip-Hop Generation, which documents the ways targeted policing in black communities coupled with harsh sentencing became a defining variable for a generation of black Americans, the Nation asked me, along with Walter Cronkite, George McGovern, Lani Guinier and other thought leaders, to each discuss a peoples-driven issue that should dominate the Democratic Party’s platform.

“Mandatory minimums disproportionately affect African-Americans [who] represent 45% of the U.S. prison population,” I wrote. “The Democratic Party should advocate the repeal of mandatory-minimum sentencing laws at the state level as well as those provisions under the federal 1984 Comprehensive Crime Control Act, the 1984 Sentencing Reform Act, the 1986 Anti-Drug Abuse Act, the 1988 Anti-Drug Abuse Act and the 1994 Crime Act.”

Coming of age in Long Island, New York, in the ’80s, I witnessed firsthand friends and relatives “caught up” by policing that targeted petty dealers and users in majority black communities, while ignoring college students, and suburban and rural Americans who, studies show, use illegal drugs at the same rate.

“Caught up” was an expression that emerged at the time, a catch-all phrase for the collateral damage of having a felony conviction. In short, once you are in the system, it is nearly impossible to avoid having its ramifications follow you in pursuit of housing, jobs, education and more for decades. These dynamics, commonplace in the state that birthed the drug laws, quickly became the national tough-on-crime blueprint.

However, after years of heavy lifting from opponents who refuse to accept a two-tiered system of justice as business as usual, in 2010 a breakthrough came with the passage of the Fair Sentencing Act. Mandatory minimum sentences were repealed for the first time for federal offenders convicted of possession of crack cocaine. Additionally the 100-to-1 ratio disparity of crack to powder cocaine was changed to 18 to 1. Crack cocaine cases in federal court dropped by 50% as a result.

But even as this leap forward underscored the extent to which U.S. drug policy was weighted with racism, it only applied to the federal prison system (a relatively small fraction of the nation’s incarceration population) and a gap remained that still more severely punished crack cocaine over powder cocaine users.

It was among former President Barack Obama’s campaign promises that fell short, even as, more than any president in history, he never wavered in insisting that we should end racial disparities and sentencing practices that punished users.

“We should not be locking up kids or individual users for long stretches of jail time when some of the folks who are writing those laws have probably done the same thing,” the president said in an interview with David Remnick in 2014. “It’s important for society not to have a situation in which a large portion of people have at one time or another broken the law and only a select few get punished.”

This shifting discourse created leverage for grassroots activists fighting for change at the state level. Similar ballot initiatives passed in California in 2014 and Oklahoma in 2016. Both report decreases in the prison population.

The frontline now comes to my current home state, Ohio, where organizations like the Ohio Organizing Collaborative, Ohio NAACP, Ohio Justice and Policy Center, and Khnemu Lighthouse in partnership with the Alliance for Safety and Justice see the possibilities.

Issue 1 is not a panacea. The legacy of racial disparities and inequalities fostered by drug policy persists — from the U.S. Census bureau’s recent decision to continue to count inmates in districts where they are incarcerated, rather than their hometowns, to redistricting maps drawn in states like Ohio that strategically places 91% of the state’s prison population in Republican districts, when most of their actual hometowns are in Democratic ones.

Likewise, a fierce debate rages on both sides of the aisle that has pushed visions of equality, justice and democracy to the brink, with both Democratic and Republican judges lecturing prospective jury pools to vote against the amendment and some voters questioning whether the change of heart for drug users is merely driven by the skin color of those most affected in Ohio by today’s opioid crisis.

No matter the outcome, what is certain is that Issue 1 is a litmus test for how far the Ohio electorate has evolved in its willingness to dismantle public policy solutions that punish blacks more severely at a time when the nation is more racially polarized than at any point in the last half century.

The passage of a bill in Michigan on Tuesday is creating buzz around Indiana.

Voters voted in favor of Proposal 1, which will legalize recreational use of marijuana in Michigan in early December for adults 21 and older.

Cannabis has been legal for medical use in Michigan since 2008. Medical marijuana is also legal in Illinois and Ohio. But Michigan is the first state that borders Indiana where recreational marijuana will be legal.This will make it easier for Indiana residents to purchase and possess marijuana.

Bill Levin, a cannabis advocate and leader of the First Church of Cannabis, at his Indianapolis home on May 19. Levin also practices what the church is preaching with a lifestyle that includes a hobby farm with animals and veggies. Levin’s farm includes a variety of chickens, peacocks, goats and other pets.

“It’s going to be a new vacation capital,” said Bill Levin, founder of the Indianapolis-based First Church of Cannabis. “It will certainly be easier than going to Colorado.”

But don’t book your Michigan trip just yet. While it will be legal to possess a small amount of marijuana in December, it won’t be available for legal recreational sales until at least 2020.

Levin said this move just highlights the fact that Indiana is missing out on an economic opportunity.

“We’re going to have legalization inevitably going to happen, so it’s a matter of if we’re going to be a leader or follower, and right now we’re a follower,” he said.

In October, a legislative interim study committee met for the first time to discuss the possibility of medical marijuana in Indiana. Rep. Jim Lucas provided testimony that he tried marijuana in Colorado and said it was the “best night sleep I’ve ever had.” Lucas plans to file a bill to legalize marijuana in the upcoming legislative session.

Marijuana remains illegal on the federal level. On Wednesday, CBS News reported that marijuana stocks rose after U.S. Attorney Jeff Sessions announced he would resign. Sessions said in January that he would revoke a policy from the Obama administration called the Cole Memorandum, which said that the federal government enforce marijuana prohibition on states that had legalized the drug.

Here’s how Michigan’s legalization of marijuana could affect Indiana.

Where does Indiana stand on marijuana?

Cannabis is illegal in Indiana. Possession of less than 30 grams is a misdemeanor offense, and more than 30 grams is a felony.

In March, Gov. Eric Holcomb signed a measure legalizing legalizing low-THC cannabidiol oil, known as CBD oil, in Indiana.

When can I buy marijuana in Michigan?

Adults 21 or older will be allowed to possess up to 2.5 ounces of marijuana starting Dec. 6, or earlier if election results are certified before then. Recreational sales won’t start until early 2020, because regulations need to be put in place and licenses issued. Medical marijuana dispensaries will have the first chance to obtain recreational licenses.

Can I bring marijuana from Michigan into Indiana?

Even if you purchase it legally in Michigan or any other state that has legalized marijuana, you cannot bring it here. Buying it legally does not make it legal to possess in Indiana.

Can I use marijuana in Michigan and drive back to Indiana?

It will still be illegal to drive under the influence of cannabis in Michigan or in Indiana.

According to an article from High Times, a marijuana news publication, you need to factor in both the dosage and concentration of the marijuana, and your metabolism and tolerance to have an accurate length of how long your high will last. But generally, a high lasts one to two hours after smoking cannabis, and three to four hours after ingesting it.

Even so, you could also get in trouble for having a trace amount of marijuana in your system, which can be detectable in bodily fluids from a few days to a few weeks after use. Indiana has a zero tolerance law for THC and metabolites, or the byproducts from the drug breaking down. So you don’t necessarily need to be high to potentially get in trouble with the law.

Captain David Bursten of the Indiana State Police said if an officer suspects impairment by a substance other than alcohol, the driver is offered a blood test.

“Those who refuse the offer of a blood test could be held for a reasonable amount of time for the investigating officer to apply for a search warrant that would require obtainment of a blood sample by a medical professional, even against the will of the suspected impaired driver,” he explained.

If the test comes back positive for illegal drugs, the driver would be summoned to court to have his or her case heard.

Indiana State Police Sergeant Ted Bohner of District 24, which includes Elkhart and St. Joseph counties that border Michigan, said it’s too early to tell if this will increase the amount of impaired drivers in Indiana.

“We’re going to keep doing business as usual,” he said. “We’re actively out there looking for impaired drivers as it is.”